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The place of new antibiotics for Gram-negative bacterial infections in intensive care: report of a consensus conference

INTRODUCTION: New beta-lactams, associated or not with beta-lactamase inhibitors (NBs/BIs), can respond to the spread of carbapenemase-producing enterobacteriales and nonfermenting carbapenem-resistant bacteria. The risk of emergence of resistance to these NBs/BIs makes guidelines necessary. The SRL...

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Autores principales: Dequin, Pierre-François, Aubron, Cécile, Faure, Henri, Garot, Denis, Guillot, Max, Hamzaoui, Olfa, Lemiale, Virginie, Maizel, Julien, Mootien, Joy Y., Osman, David, Simon, Marie, Thille, Arnaud W., Vinsonneau, Christophe, Kuteifan, Khaldoun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10317910/
https://www.ncbi.nlm.nih.gov/pubmed/37400647
http://dx.doi.org/10.1186/s13613-023-01155-4
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author Dequin, Pierre-François
Aubron, Cécile
Faure, Henri
Garot, Denis
Guillot, Max
Hamzaoui, Olfa
Lemiale, Virginie
Maizel, Julien
Mootien, Joy Y.
Osman, David
Simon, Marie
Thille, Arnaud W.
Vinsonneau, Christophe
Kuteifan, Khaldoun
author_facet Dequin, Pierre-François
Aubron, Cécile
Faure, Henri
Garot, Denis
Guillot, Max
Hamzaoui, Olfa
Lemiale, Virginie
Maizel, Julien
Mootien, Joy Y.
Osman, David
Simon, Marie
Thille, Arnaud W.
Vinsonneau, Christophe
Kuteifan, Khaldoun
author_sort Dequin, Pierre-François
collection PubMed
description INTRODUCTION: New beta-lactams, associated or not with beta-lactamase inhibitors (NBs/BIs), can respond to the spread of carbapenemase-producing enterobacteriales and nonfermenting carbapenem-resistant bacteria. The risk of emergence of resistance to these NBs/BIs makes guidelines necessary. The SRLF organized a consensus conference in December 2022. METHODS: An ad hoc committee without any conflict of interest (CoI) with the subject identified the molecules (ceftolozane–tazobactam, ceftazidime–avibactam, imipenem–cilastatin–relebactam, meropenem–vaborbactam and cefiderocol); defined 6 generic questions; drew up a list of subquestions according to the population, intervention, comparison and outcomes (PICO) model; and reviewed the literature using predefined keywords. The quality of the data was assessed using the GRADE methodology. Seven experts in the field proposed their own answers to the questions in a public session and answered questions from the jury (a panel of 10 critical-care physicians without any CoI) and the public. The jury then met alone for 48 h to write its recommendations. Due to the frequent lack of powerful studies that have used clinically important criteria of judgment, the recommendations were formulated as expert opinions as often as necessary. RESULTS: The jury provided 17 statements answering 6 questions: (1) Is there a place in the ICU for the probabilistic use of new NBs/IBs active against Gram-negative bacteria? (2) In the context of documented infections with sensitivity to several of these molecules, are there pharmacokinetic, pharmacodynamic, ecological or medico-economic elements for prioritization? (3) What are the possible combinations with these molecules and in what context? (4) Should we integrate these new molecules into a carbapenem-sparing strategy? (5) What pharmacokinetic and pharmacodynamic data are available to optimize their mode of administration in critically ill patients? (6) What are the dosage adaptations in cases of renal insufficiency, hepatocellular insufficiency or obesity? CONCLUSION: These recommendations should optimize the use of NBs/BIs in ICU patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13613-023-01155-4.
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spelling pubmed-103179102023-07-05 The place of new antibiotics for Gram-negative bacterial infections in intensive care: report of a consensus conference Dequin, Pierre-François Aubron, Cécile Faure, Henri Garot, Denis Guillot, Max Hamzaoui, Olfa Lemiale, Virginie Maizel, Julien Mootien, Joy Y. Osman, David Simon, Marie Thille, Arnaud W. Vinsonneau, Christophe Kuteifan, Khaldoun Ann Intensive Care Review INTRODUCTION: New beta-lactams, associated or not with beta-lactamase inhibitors (NBs/BIs), can respond to the spread of carbapenemase-producing enterobacteriales and nonfermenting carbapenem-resistant bacteria. The risk of emergence of resistance to these NBs/BIs makes guidelines necessary. The SRLF organized a consensus conference in December 2022. METHODS: An ad hoc committee without any conflict of interest (CoI) with the subject identified the molecules (ceftolozane–tazobactam, ceftazidime–avibactam, imipenem–cilastatin–relebactam, meropenem–vaborbactam and cefiderocol); defined 6 generic questions; drew up a list of subquestions according to the population, intervention, comparison and outcomes (PICO) model; and reviewed the literature using predefined keywords. The quality of the data was assessed using the GRADE methodology. Seven experts in the field proposed their own answers to the questions in a public session and answered questions from the jury (a panel of 10 critical-care physicians without any CoI) and the public. The jury then met alone for 48 h to write its recommendations. Due to the frequent lack of powerful studies that have used clinically important criteria of judgment, the recommendations were formulated as expert opinions as often as necessary. RESULTS: The jury provided 17 statements answering 6 questions: (1) Is there a place in the ICU for the probabilistic use of new NBs/IBs active against Gram-negative bacteria? (2) In the context of documented infections with sensitivity to several of these molecules, are there pharmacokinetic, pharmacodynamic, ecological or medico-economic elements for prioritization? (3) What are the possible combinations with these molecules and in what context? (4) Should we integrate these new molecules into a carbapenem-sparing strategy? (5) What pharmacokinetic and pharmacodynamic data are available to optimize their mode of administration in critically ill patients? (6) What are the dosage adaptations in cases of renal insufficiency, hepatocellular insufficiency or obesity? CONCLUSION: These recommendations should optimize the use of NBs/BIs in ICU patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13613-023-01155-4. Springer International Publishing 2023-07-04 /pmc/articles/PMC10317910/ /pubmed/37400647 http://dx.doi.org/10.1186/s13613-023-01155-4 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Review
Dequin, Pierre-François
Aubron, Cécile
Faure, Henri
Garot, Denis
Guillot, Max
Hamzaoui, Olfa
Lemiale, Virginie
Maizel, Julien
Mootien, Joy Y.
Osman, David
Simon, Marie
Thille, Arnaud W.
Vinsonneau, Christophe
Kuteifan, Khaldoun
The place of new antibiotics for Gram-negative bacterial infections in intensive care: report of a consensus conference
title The place of new antibiotics for Gram-negative bacterial infections in intensive care: report of a consensus conference
title_full The place of new antibiotics for Gram-negative bacterial infections in intensive care: report of a consensus conference
title_fullStr The place of new antibiotics for Gram-negative bacterial infections in intensive care: report of a consensus conference
title_full_unstemmed The place of new antibiotics for Gram-negative bacterial infections in intensive care: report of a consensus conference
title_short The place of new antibiotics for Gram-negative bacterial infections in intensive care: report of a consensus conference
title_sort place of new antibiotics for gram-negative bacterial infections in intensive care: report of a consensus conference
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10317910/
https://www.ncbi.nlm.nih.gov/pubmed/37400647
http://dx.doi.org/10.1186/s13613-023-01155-4
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